Provider Demographics
NPI:1093491045
Name:RAYS OF LIGHT ABA LLC
Entity Type:Organization
Organization Name:RAYS OF LIGHT ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-757-5841
Mailing Address - Street 1:268 CRYSTAL CREEK LN BASEMENT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157
Mailing Address - Country:US
Mailing Address - Phone:678-757-5841
Mailing Address - Fax:
Practice Address - Street 1:268 CRYSTAL CREEK LN BASEMENT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157
Practice Address - Country:US
Practice Address - Phone:678-757-5841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty